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971 30 23 54

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Appointments

Mondays to Fridays: 8:00 - 21:00
Saturdays: 8:00 - 14:30

971 30 23 54

Request for Access to Medical History

PATIENT
REPRESENTATIVE (only in case of representation, disability, or unemancipated minors under 14 years of age):

The legal representative declares on his own responsibility that, at the date of this request, there is no circumstance which may affect the validity of the supporting documentation submitted concerning the legal representation of the interested party.

Likewise, in the event that the exercise of the right has been carried out by one of the minor's parents, he/she declares that he/she is acting within the ordinary exercise of parental authority, always with the knowledge and consent of the other parent, in accordance with the provisions of Article 156 of the Civil Code.

PREFERRED NOTIFICATION CHANNEL
I EXPOSE

I wish to exercise my right of access to certain data, pursuant to Article 15 of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016, Article 13 of Organic Law 3/2018 of 5 December on the protection of personal data and guarantee of digital rights, and Article 18 of Law 41/2002 of 14 November, regulating patient autonomy and rights and obligations in relation to clinical information and documentation.

I REQUEST

That I am provided with information relating to the processing of personal data to which I have the right of access within one month of the date of registration of this request.

Period
ATTACHED DOCUMENTATION
INSTRUCTIONS

Write in capitals.

  1. If the application is made by a representative, all the patient's details must be entered in the corresponding section (‘Patient’).
    1. Parent: natural person who exercises parental authority. If the request is submitted by a parent, proof of this status must be provided by presenting the corresponding document. In accordance with Article 156 of the Civil Code, with regard to third parties acting in good faith, it is presumed that each parent acts in the ordinary exercise of parental authority with the consent of the other.
    2. Legal guardian:natural person who exercises guardianship over a minor or incapacitated person. If the application is submitted through a legal guardian, this status must be proven and the document justifying it must be provided.
    3. Representative: Anyone acting as a representative must prove the capacity in which they are acting by any means valid in law that provides reliable evidence of this circumstance. 

  2. A copy of the patient's identity card must be provided, and in the case of a representative, a copy of the identity card of the parent, legal guardian or representative. All personal documentation provided must be valid.

POLICLÍNICA NTRA. SRA. DEL ROSARIO, S.L.U. is the Controller of the User’s personal data and informs that such data will be processed in accordance with Regulation (EU) 2016/679 of 27 April (GDPR) and Organic Law 3/2018 of 5 December (LOPDGDD).

The purposes of the processing are to maintain a commercial relationship (based on the legitimate interest of the Controller, art. 6.1.f GDPR) and to send communications regarding products or services (based on the consent of the Data Subject, art. 6.1.a GDPR).

Data will be stored only for as long as necessary to fulfil the purposes for which they were collected or for the period required by applicable law. Once these purposes no longer apply, the data will be securely deleted or anonymized.

No data will be disclosed to third parties unless there is a legal obligation to do so.

Users may exercise their rights to withdraw consent at any time, as well as their rights of access, rectification, portability, and erasure of data, and the limitation or objection to their processing. They may also file a complaint with the Spanish Supervisory Authority (www.aepd.es) if they consider that the processing does not comply with current legislation.

To exercise these rights, users can contact lopd@grupopoliclinica.es. The Data Protection Officer can be reached at dpo@tecnolawyer.com.

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Teléfono citas

971 30 23 54

Facebook-f Instagram Youtube X-twitter Linkedin

Appointments

971 30 23 54

Grupo Policlínica
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